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General NPI Number Information
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NPI Number | 1538609888
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Entity Type | Organization
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Legal Business Name | BEPROACTIVE FOUNDATION, INC
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Dates
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Enumeration Date | 03/06/2017
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Last Update Date | 03/06/2017
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Provider Practice Location Address
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Address Line | 1830 WATER PL SE STE #220
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City | ATLANTA
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State | GA
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Zip | 30339-7407
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Country | US
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Telephone | 770-319-7468
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Fax | 866-416-1767
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Provider Business Mailing Address
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Address Line | 1830 WATER PL SE STE #220
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City | ATLANTA
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State | GA
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Zip | 30339-7407
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Country | US
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Telephone | 770-319-7468
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Fax | 866-416-1767
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. RJ LEWIS
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Credential | M.A.
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Telephone | 770-319-7468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | GA
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